Fiber based medical devices and aspiration catheters

ABSTRACT

Systems for less invasive medical procedures comprise a filter device mounted on an integrated guiding structure and an aspiration catheter. These components can be used together or separately, and the system can be used with other medical devices that are designed for less invasive procedures, such as procedures in a patient&#39;s vasculature. The filter device can involve improved torque coupling with a torque coupler associated with a resilient member that correspondingly also provides increased flexibility relative to an overtube that forms a tube for the remaining portions of the device. An actuation tool for the filter device used a systematic loading procedure for proper loading of the corewire and overtube into the actuation tool. A fiber cartridge comprises fibers loaded as a bundle into the cartridge for delivery with the ends of the fibers respectively bonded to radiopaque markers that can be visualized to come together when the filter is properly deployed. The aspiration catheter generally has a rapid exchange format. The catheter can have a radiopaque band that is held in place under metal wire embedded within the polymer forming the tube of the catheter. In some embodiments, the aspiration catheter has a small diameter distal portion that can access into small diameter vessels in which the distal portion has a smaller average diameter than the remaining tube of the catheter.

FIELD OF THE INVENTION

The invention relates to medical devices, such as fiber-based vasculardevices, for less invasive medical procedures, such as embolicprotection and/or embolectomy procedures. Thus, the devices are able tocapture and retrieve thrombus and debris generally from vessels, inwhich the thrombus or debris is preexisting in the vessel or generatedby a procedure in the vessel with the filter device in a deployedconfiguration. The invention further relates to aspiration cathetersthat are suitable for retrieving the fiber-based device as well as forperforming thrombectomy procedures and the like.

BACKGROUND OF THE INVENTION

A variety of procedures are performed with less invasive approaches toreach distant locations within a patient's body. These procedures can beused, for example, for entry into the abdominal cavity or into theurinary track, or for reaching the patient's genitals. However, many ofthe procedures are performed within the cardiovascular system. For anyof these procedures, a guidewire can be used to snake through thepatient to position the tip of the guidewire at a desired location. Acatheter and/or other medical devices can be positioned by sliding themover the guidewire to the appropriate location.

Generally, to position the guidewire, the guidewire traverses along apathway, such as through vessels of the cardiovascular system, that hasbends and branches. To navigate along the curves and branches, theguidewires and catheters are flexible. To steer the device to thedesired location, some control generally should be possible with respectto directing the tip of the device for steering along curves andbranches in the desired pathway. Through the application of torque atthe proximal end of the device protruding from the patient, the tip canbe guided along a selected path within the patient. The delivery of thedevice is facilitated through the use of real time imaging.

Many less invasive procedures create the possibility of emboli formationas a result of the procedure. Also, some procedures may be specificallyinitiated to capture and/or remove emboli, which are generated or have arisk of being generated through another mechanism. An embolus can be anyparticle comprising a foreign and/or native material, which enters thevascular system or other vessel of the body with potential to causeocclusion of flow, e.g., blood flow. Emboli can be formed fromaggregates of fibrin, blood cells or fragments thereof, collagen,cholesterol, plaque, fat, calcified plaque, bubbles, arterial tissue,and/or other miscellaneous fragments or combinations thereof. Emboli canlodge, for example, in the narrowing regions of medium size bloodvessels that feed the major organs. Loss of blood flow to surroundingtissue causes localized cell death or micro-infarcts. Cerebralmicro-infarcts can cause stroke leading to confusion, disturbance ofspeech, paralysis, visual disturbances, balance disturbances and evendeath. In the heart, emboli can cause myocardial infarcts, i.e. heartattacks. Myocardial infarction refers to the death of a section ofmyocardium or middle layer of the heart muscle. Myocardial infarctioncan result from at least partial blockage of the coronary artery or itsbranches. Blockage of capillaries associated with the coronary arteriescan result in corresponding micro-infarctions/micro-infarcs. Resultingimpairments are frequently short term but can be permanent.

Many clinical procedures can result in emboli including, for example,coronary, carotid, and peripheral interventions. In these cases,particulate matter, including, for example, plaque, debris and thrombus,can form emboli distal to the site of intervention. As a result, bloodflow to the distal vascular bed can be diminished and periproceduralend-organ ischemia and infarction can result. Distal embolization oflarge particles produced at the time of such interventions as ballooninflation or stent deployment may obstruct large, epicardial vessels,and smaller particles (as small as 15-100 microns) can causemicro-infarcts and/or myocardial infarctions and left ventriculardysfunction.

A significant reason for ischemic injury during percutaneous procedurescan be generation of emboli that block smaller distal vessels. Oneapproach to curb this complication has been to use pharmacologicaltherapies during the time of the intervention. Limited therapeuticsuccess has been reported with the use of calcium channel blockers,adenosine, and sodium nitroprusside (Webb, J G, Carere, R G, Virmani, R,Baim, D, Teirstein, P S, Whitlow, P, McQueen, C, Kolodgie, F D, Buller,E, Dodek, A, Mancini, G B, & Oesterle, S: Retrieval and analysis ofparticulate debris after saphenous vein graft intervention. J Am CollCardiol 2000, 34:468-475, incorporation herein by reference.).Glyoprotein IIb/IIIa inhibitors have been used for percutaneous coronaryinterventions to reduce platelet aggregation, but also fail to showmeaningful long term clinical benefit. (Mathew, V, Grill, D E, Scott, CG, Grantham, J A, Ting, H H, Garratt, K N, & Holmes, D R, Jr. Theinfluence of abciximab use on clinical outcome after aortocoronary veingraft interventions. J Am Coll Cardiol 1999, 34:1163-1169 and Mak, K H,Challapalli, R, Eisenberg, M J, Anderson, K M, Califf, R M, & Topol, EJ: Effect of platelet glycoprotein IIb/IIIa receptor inhibition ondistal embolization during percutaneous revascularization ofaortocoronary saphenous vein grafts. EPIC Investigators. Evaluation ofIIb/IIIa platelet receptor antagonist 7E3 in Preventing IschemicComplications. Am J Cardiol 1997, 80:985-988, both of which areincorporated herein by reference.) Since embolization often developsfrom physical disruption of fibrotic plaque, a mechanism of therapeuticembolic protection specifically targeted at prevention of plateletaggregation and blood clotting may have little effect on thesealready-formed, embolizable plaques.

SUMMARY OF THE INVENTION

In a first aspect, the invention pertains to an actuation tool formanipulating a medical device comprising an overtube and a corewirewithin a lumen of the overtube, wherein a proximal end of the corewireextends from a proximal end of the overtube. The actuation toolcomprises a support structure, an overtube connection supported by thesupport structure, a corewire connection supported by the supportstructure, an adjustable channel and a control element comprising arotatable element, such as a knob, and a lateral transmission operablyconnected to the adjustable channel. The overtube connection comprises afastening element configured for gripping the overtube at or near itsproximal end with the corewire extending outward from the overtube. Thecorewire connection generally comprises a corewire connecting elementconfigured to grip the corewire at or near its proximal end. Theadjustable channel can comprise slidably engaging elements forming alumen between the engaging elements. The adjustable channel is supportedwithin the body with the adjustable channel extending between the tubeconnection and the corewire connection. The lumen of the adjustablechannel has a diameter larger than the diameter of the corewire. Thelateral movement of the engaging elements changes the relative distanceof the overtube connection and the corewire connection. The transmissionof the control element converts rotational motion of the rotatableelement to relative translational motion of the engaging elements toadjust the relative distance of the overtube connection and the corewireconnection to move the proximal ends of the tube and the corewire towardor away from each other when the overtube and corewire are respectivelygripped by the corewire connection and the overtube connection.

In further embodiments, the invention pertains to a fiber-based devicecomprising an overtube, a corewire and a fiber cartridge. The overtubecomprising a proximal end, a distal end, and a lumen extendingtherethrough. The corewire comprises a proximal end and a distal end,and the corewire extends through the lumen of the overtube. The fibercartridge comprises a bundle of flexible fibers, a first radiopaquemarker and a second radiopaque marker. The first radiopaque marker isassociated directly or indirectly with a first end of the bundle offibers. The second radiopaque marker is associated directly orindirectly with a second end of the bundle of fibers, and the fibercartridge has a deployed configuration having the first marker band andthe second marker band projecting a single merged image. In someembodiments, the first radiopaque marker comprises a first tube, and thesecond radiopaque marker comprises a second tube, each tube having alumen through the center of the tubes. The bundle of fibers can compriseflexible polymer fibers.

In other aspects, the invention pertains to a medical device comprisingan overtube, a corewire, a resilient segment and a torque coupler. Theovertube comprises a proximal end, a distal end, and a lumen extendingtherethrough. Also, the corewire comprises a proximal end and a distalend, and the corewire extends through the lumen of the overtube with theproximal end of the corewire extending from the proximal end of theovertube and the distal end of the corewire extending from the distalend of the overtube. The resilient segment generally directly orindirectly attaches to the distal end of the tub. Furthermore, thetorque coupler comprising a corewire coupling element integral with thecorewire and a resilient segment coupling element integral with theresilient segment in which the corewire coupling element engages withthe resilient segment coupling element to couple the rotational motionof the resilient segment with the corewire.

In additional aspects, the invention pertains to a catheter comprising atube, a radiopaque band and metal wire. The tube comprises a polymer,and the tube has a proximal portion and a distal portion. The radiopaqueband generally is in contact with the distal portion of the tube. Themetal wire generally has at least a portion of which embedded in thepolymer and is extending over the radiopaque band.

Furthermore, the invention pertains to an aspiration catheter comprisinga connector, a proximal portion, a distal tip and a tube connectedbetween the distal tip and the proximal portion. The connector generallyis attached to the proximal portion to provide a passageway to thedistal tip through a continuous lumen extending from the proximalportion to the distal tip. In some embodiments, the distal tip has anaverage outer diameter from about 25 percent to about 90 percent of theaverage outer diameter of the tube.

Moreover, the invention pertains to a method for loading a medicaldevice into an actuation tool. The medical device comprises an overtubeand a corewire within a lumen of the tube with a proximal end of thecorewire extending from a proximal end of the tube. The actuation toolcomprises an overtube connection and a corewire connection eachconnected to a support structure supporting a control element with anadjustable channel. In some embodiments, the corewire connectioncomprising a viewing area, such as a window, for observing the corewire.The method comprises guiding the proximal end of the corewire into theovertube connection, the adjustable channel, and the corewire connectionuntil observing the corewire through the viewing area indicating properplacement of the corewire. The method further comprises engaging thecorewire connection to grip the corewire extending from the proximal endof the overtube, and engaging the tube connection onto the proximal endof the overtube.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1A is a side view of a filter device comprising an integratedguiding device with a fiber cartridge.

FIG. 1B is a side view of the core wire of the filter device of FIG. 1Aseparate from the remaining components of the filter device.

FIG. 2A is a fragmentary side view of an alternative embodiment of aresilient element comprising cut tubing with a section of cut slots anda spiral cut section.

FIG. 2B is an expanded fragmentary view of the resilient element withcut slots adjacent an uncut section of the overtube in which the view istaken at the B marked portion of FIG. 2A.

FIG. 2C is an expanded fragmentary view of the spiral cut portion of theresilient element in which the view is taken at the C marked portion ofFIG. 2A.

FIG. 3A is a side view of the torque coupler of FIG. 1 that interfacesthe overtube with the corewire.

FIG. 3B is a sectional view of the torque coupler taken at line 3B-3B inFIG. 3A.

FIG. 3C is a sectional view of the corewire and the overtube takenoutside the torque coupler at line 3C-3C of FIG. 3A.

FIG. 4A is a side view of the torque coupler of FIG. 1 that interfacesthe resilient element with the corewire.

FIG. 4B is a sectional view of the torque coupler taken at line 4B-4B inFIG. 4A.

FIG. 4C is a sectional view of the corewire and the resilient elementtaken outside the torque coupler along line 4C-4C of FIG. 4A.

FIG. 5 is a perspective view of the fiber cartridge from the filterdevice of FIG. 1 separated from the other components.

FIG. 6 is a sectional view of the fiber cartridge of FIG. 5 taken alongthe longitudinal axis of the fiber cartridge.

FIG. 7 is a fragmentary view of the fiber cartridge of FIG. 5 in adeployed configuration with only a portion of the flares fibers shown.

FIG. 8A is a side view of an alternative embodiment of a filter devicewith a fiber cartridge in a delivery configuration.

FIG. 8B is a side view of the filter device of FIG. 8A with the fibercartridge in a flared configuration.

FIG. 9 is a side plan view of an actuation tool for moving the corewirerelative to the overtube to control deployment the fiber cartridge.

FIG. 10 is a perspective view of the actuation tool of FIG. 9 in apartially exploded format to show components internal to a housing.

FIG. 11 is a side view of the actuation tool of FIG. 9 with structureremoved to expose internal features of the tool.

FIG. 12 is a top view of an alternative embodiment of an actuation tool.

FIG. 13 is an end view of the actuation tool of FIG. 12.

FIG. 14 is a bottom edge view of the actuation tool of FIG. 12.

FIG. 15 is an exploded perspective view of the loading funnel of theactuation tool of FIG. 12.

FIG. 16 is a top perspective view of a second alternative embodiment ofan actuation tool in a load configuration.

FIG. 17 is top perspective view of the actuation tool of FIG. 16 in anactuation configuration in which the dial is exposed.

FIG. 18 is a side view of a rapid exchange aspiration catheter.

FIG. 18A is a fragmentary expanded view of the catheter of FIG. 18 takenat the position labeled A.

FIG. 18B is a fragmentary expanded view of the catheter of FIG. 18 takenat the position labeled B taken at the tip of the catheter.

FIG. 19 is a top view of the catheter of FIG. 18 in which the view isrotated 90 degrees relative to the view of FIG. 18 to show the curvatureof the tip.

FIG. 19A is a fragmentary expanded view of the catheter of FIG. 18 atthe orientation of FIG. 19 taken at the position labeled A.

FIG. 19B is a fragmentary expanded view of the catheter of FIG. 19 atthe orientation of FIG. 19 taken at the position labeled B taken at thetip of the catheter.

FIG. 20 is a fragmentary side view of an aspiration catheter having anarrow diameter distal segment for placement in small vessels within thebody.

DETAILED DESCRIPTION OF THE INVENTION

A system for effectively trapping and removing emboli and thrombus fromvessels of the body, such as blood vessels, generally comprises afiber-based device and an aspiration catheter, which can be usedtogether, separately and/or with other medical treatment devices. Thefiber-based device can interface with an integrated guiding structurethat provides for delivery of the device as well as deployment andcollapse of the device for recovery. Improved integrated guidingstructures described herein provide a torque coupler interfaced with aresilient segment, to improve flexibility and maneuverability of thestructure. The fiber-based device, which can function as a filter insome embodiment, can comprise a fiber cartridge with fibers. An improvedfiber cartridge can comprise two radiopaque elements or markers thatcome together when the filter is properly deployed for easiervisualization regarding the filter status. An actuation tool cancomprise a rotatable element with optional locking element(s) that canbe used for controlled movement of a corewire relative to an overtube ofthe integrated guiding structure, such as to control deployment and/orcollapse of a fiber-based element. The actuation tool provides for easeof use as well as designs that reduce the chance of improper loading andimproper deployment of the corresponding medical device. The aspirationcatheter can have radiopaque bands that are held in place underreinforcing wires embedded into the catheter walls. The secured bandshave a reduced chance of catching on structure within a patient'svessel, such as a blood vessel, such that the safety of the procedure isimproved. In some embodiments, the aspiration catheter, generally in arapid deployment format, can have a narrow diameter distal segment forplacement of the segment into small diameter vessels, such as bloodvessels in the brain.

The devices described herein are generally useful for procedures withinvessels of a patient, such as blood vessels. The patients are generallyhumans, although suitable patients include farm animals, pets and thelike. Blood vessels of particular interest include, for example,coronary arteries, saphenous vein grafts (SVG's), carotid arteries,femoral arteries, peripheral arteries and other arteries of the brain.In general, delivery of the devices to selected locations involvestracking the device around various curves and past branches in thevessels. When maneuvering the integrated guiding device within the bloodvessel, torque couplers can prevent the components of device fromtwisting, and resilient elements can help steer the device in the bloodvessel. One or more functional medical structures can be delivered overor integrated with the integrated guiding device to treat plaque buildup on blood vessel walls. An aspiration catheter can be used to removethe debris that is generated from treating plaque on the blood vesselwalls and finally to retrieve the functional medical structure.

In general, the treatment systems described herein comprise afiber-based system, which can be a filter system, and an aspirationcatheter. While these devices can be advantageously used together as asystem, the fiber-based element can be used independently or with adifferent aspiration catheter. Similarly, the aspiration catheter can beused separately to perform thrombectomy procedures without a filterand/or in procedures with different types of filters and/or othermedical devices. As described in detail below, the fiber-based devicecomprises an integrated guide structure with a fiber cartridge mountedon the integrated guide structure, which functions to control deploymentand collapse of the fiber cartridge to a lower profile configuration.However, in some embodiments, alternative functional medical componentscan be mounted on the integrated guide structure for correspondingmedical procedures.

The fiber cartridge generally comprises fibers that are within a compactbundle in a delivery configuration, and that flare outward near theircenters in a deployed configuration so that the fibers can fill a vessellumen as a three dimensional filtration matrix. In the fiber device, thefiber cartridge is interfaced with the components of the integratedguide structure in which the movement of the end elements of the fibercartridge respectively holding fixed the fiber ends are translatedrelative to each other based on movement of the components of theintegrated guide structure.

An integrated guiding structure comprises a corewire and an overtube(e.g. a hypotube or polytube) that receives the corewire. The proximalend of the corewire extends from the proximal end of the overtube. Thecorewire and the overtube can be provided with additional structure orestablish a structural relationship that enables longitudinal movementof the corewire with respect to the overtube, providing communicationbetween the proximal and distal ends of integrated guiding device withthe fiber cartridge and/or other functional medical structure locatednear the distal end of the integrated guiding structure. The integratedguiding device can also comprise one or more torque couplers. Forflexibility and steerability, one or more resilient elements can beassociated with the corewire or overtube or both.

Torque couplers provide considerable advantages with respect to deliveryof the integrated guiding device by rotationally coupling the componentsand providing desired longitudinal motion of the integrated guidingdevice. Torque couplers can be used to rotationally couple the corewirewith the overtube to reduce or prevent twisting of the corewire relativeto the overtube. It has been found the overtube can be rotationallycoupled with the resilient element even though the resilient element hasa greater elasticity relative to the overtube. Through the use of atorque coupler associated with a resilient member significantly improvedtorque transmission to the distal end of the integrated guide structurecan be achieved. With the components of the integrated guiding devicerotationally coupled, the corewire and the overtube can be manipulatedor guided to a specific location within the patient through manipulatingthe portion of the device extending from the patient. Specifically, thetorque applied externally to the patient near the proximal end of theintegrated guiding structure can be transferred to the distal end of theintegrated guiding structure within the patient's vessel.

Torque couplers can be particularly useful for corewires and overtubeswith small cross sections. When the corewires and overtubes have suchthin cross sections, the corewire can twist, such that torque cannot beefficiently transferred from the proximal end of the integrated guidingstructure to the distal end of the corewire without the torque coupler.Torque can be transferred better from the proximal end to the distal endof the integrated guiding device when a torque coupler couples thecorewire and overtube to provide torque transmittal, i.e. rotationalcommunication, between the overtube and corewire.

To facilitate steering of integrated guiding device, the flexibility ofthe overtube can be enhanced by a resilient member, such as a coil or aslotted segment. The properties of the resilient member can be selectedto provide the desired degree of flexibility of the structure. In someembodiments, a resilient member is located at or adjacent the distal endof the overtube to provide flexibility for guiding the integrated guidestructure through tortuous vessels of a patient. The coil can be weldedor otherwise fastened to the overtube with the coil abutting the distalend of the overtube, or the coil can overlap with a distal portion ofthe overtube, such as a tapered segment of the overtube. In additionalor alternative embodiments, a coil pattern can be cut into the overtubeto form a resilient element. In some embodiments slotted segments canhave the advantages of improved flexibility while providing appropriatelevels of mechanical stability since more resilient coils can distorttheir shape beyond a desired amount. In some embodiments, it can bedesired to have both a coil and a slotted segment associated with theovertube in a selected configuration at the distal end of the overtube.

Slotted segments generally comprise a plurality of slots of selecteddimensions and orientations. Slots may or may not cut through theovertube, i.e., the slots may be cut to remove material without passingthrough the full thickness of the material. While the overtube withdesired slots, in principle, can be formed from any appropriate method,convenient approaches involve the formation of the slots after the basicstructure of the overtube is formed. In some embodiments, two opposingslots can be cut into the overtube, leaving an area of tube between thetwo opposing slots. Additional pairs of opposing slots can be spacedapart a selected amount from adjacent pairs of opposing slots. Infurther embodiments, pairs of opposing slots can be rotated, e.g., about90 degrees, around the circumference of the overtube relative toadjacent pairs of slots. The slot may or may not be cut perpendicular tothe central axis of the overtube, and in some embodiments, the slots arecut at a selected angle. The slots can be cut into the overtube usingany practical approach, such as laser cutting.

The fiber cartridge comprises a bundle of flexible fibers with a firstend secured together, optionally engaged with a first tube and with asecond end secured together, optionally engaged with a second tube. Thefibers can be surface capillary fibers with lengths appropriate for thesize of the vessel. The first end of the fibers is secured to a firstradiopaque marker, such as a radiopaque tube, and the second end issecured to a second radiopaque marker, such as a second tube. When thefirst radiopaque marker and the second radiopaque marker moves towardand away from the other, the bundle of fibers respectively flare into adeployed filter structure and collapse into a low profile configuration.It has been observed for some fiber cartridge embodiments that atwisting of the fiber bundle during the loading of the cartridge leadsto more uniform deployment of the fiber structure upon deployment in avessel. Similarly, the fibers of the fiber bundle can be heated to forma more effective filter element. The deployed fiber cartridge generallycan fill a lumen within a body with a three dimensional filtrationmatrix, although for embolectomy applications, the filtering functionmay be secondary. The tubes are placed onto the corewire with thecorewire extending through the lumen of the short tubes. The first tubeis secured to move with the overtube, and the second tube is secured tomove with the corewire. The first and second tubes, associated with thefiber cartridge can comprise a radiopaque material to permit x-rayobservation of the tubes when they are within the body, although othermarker structures/material can be effectively associated with therespective ends of the fiber cartridge. The tubes of the fiber cartridgecan have appropriate diameters as well as appropriate selected lengthsto permit insertion of at least a portion of one tube into the othertube. The ability to see the markers coming together throughvisualization in the body provides greater confidence that the fibercartridge is properly deployed and that the fibers are flared a selectedamount.

An actuation tool for the integrated guide structure can be used toprovide controlled longitudinal motion of the corewire relative to theovertube to control the configuration of the fiber cartridge or otherfunctional medical structure that is within the patient from outside thepatient. Generally, the actuation tool comprises a support structure, atransmission, an overtube connection, a corewire connection, anadjustable channel, and a rotatable element. The actuation tool can beattached to the proximal end of the corewire using the corewireconnection and the proximal end of the overtube using the overtubeconnection. Through the action of the transmission, rotating a rotatableelement, such as a dial or lever, produces controlled relativelongitudinal motion of the corewire and overtube connections to move theproximal ends of the overtube and corewire relative to each other tooperate the integrated guiding device. A lock can stop the rotatableelement at the appropriate degree of rotation to properly deploy thefilter. The lock can be disengaged, such as through the depression of abutton or the like, to collapse the fiber cartridge into a recoveryconfiguration. Another lock element, such as a removable structure,e.g., a clip, can prevent rotation of the rotatable element prior to aselected time to deploy the fiber cartridge. The adjustable channel canbe fashioned to provide support for effectively the entire length of thecorewire. Specifically, the channel can have a sufficiently small crosssection, such that there is nominal clearance between the corewire andthe channel.

Generally, an aspiration catheter comprises a tube and an aspirationconnection for connection to a suction device. While it can be desirablefor the tube to have a single lumen, in some embodiments, the tube canhave a plurality of lumen over all or a portion of the length of thetube. An aspiration catheter can be used to retrieve the fiber cartridgeand/or to aspirate thrombus or debris generated from treating thevessel. To facilitate positioning of the distal end of the catheter nearthe selected position in the vessel, one or more radiopaque bands aremounted near the distal end of the catheter to permit x-ray observationof the position of the catheter within the body. If a plurality ofradiopaque bands is used, they can be located along different portionsof the tube, which can provide further indication of position andorientation of portions of the catheter within the body. In someembodiments, the catheter body is formed of polymer, and metal wire,which can be formed into a mesh or the like, which is embedded into thepolymer to provide a desired amount of mechanical strength whileproviding appropriate flexibility. In improved embodiments describedherein, the metal wire, such as a metal sleeve, can be provided over theradiopaque band(s) to secure the radiopaque band and reduce thepossibility of the radiopaque band catching onto structure within thevessel, such as a stent or thrombus, which can complicate the procedureand can result in the removal of the band from the catheter. The metalsleeve can comprise of interwoven wires, a coiled wire or the like.

With respect to the selection of catheter size, a larger catheterprovides a corresponding increase in the ability to aspirate fluid fromthe vessel while a desire to enter into smaller vessels limits the sizeof the catheter since larger catheters cannot be maneuvered into smallervessels and can excessively block flow within smaller vessels. In someembodiments described herein, the aspiration catheter has a distalsegment with a smaller diameter relative to the majority of the cathetertube. These catheter designs provide a better balance of aspirationabilities while providing the capability of entering smaller vessels.Thus, in some embodiments the aspiration catheter can be sized andshaped to enter small blood vessels in the brain for treatment of strokeor other procedures performed in these vessels.

If a fiber-based device is used in a system with the aspirationcatheter, the aspiration catheter is generally used as a retrievalcatheter to facilitate removal of the fiber-based device from thepatient. In particular, aspiration can be applied when the fibercartridge is being collapsed and/or as the fiber cartridge is drawn intothe distal end of the catheter. The use of aspiration results in thecapture of emboli inadvertently released from the filter during removalfrom the vessel. In some embodiments, the fiber cartridge can be used inan embolectomy procedure by dragging an obstruction or thrombus into thecatheter by moving the deployed fiber cartridge toward the cathetergenerally with the use of aspiration. The embolectomy procedure can beperformed to remove a blockage from a blood vessel such as in the brainto treat an acute stroke event.

The improved features described above can be used together orindividually within a particular medical system. Specifically, animproved fiber-based device can comprise a fiber cartridge that providesfor improved visualization of fiber deployment through the use ofradiopaque markers bonded to the respective fiber ends. The fiber-baseddevice can have improved manueverability through the use of a torquecoupler associated with a resilient member near the distal end of anovertube within the integrated guide structure. An improved actuationtool provided for easier deployment of the filter into a properconfiguration and collapse of the fiber-based element for removal fromthe vessel. The aspiration catheter can be designed with radiopaquebands that are less likely to catch on structure within the vessel. Insome embodiments, a reduced diameter distal tip provides for effectivedelivery of the catheter tip into small vessels, such as blood vesselsof the brain, for procedures in small vessels. Thus, these devices canbe effective for critical medical procedures.

Fiber-Based Device

The fiber-based devices described herein generally comprise anintegrated guide structure and a fiber cartridge with fibers mountedonto the integrated guide structure. The fibers in the fiber cartridgeare configured as a bundle with fibers aligned into a low profileconfiguration for delivery. Upon deployment of the fiber cartridge, thefibers flair outward from near their center into a deployedconfiguration, generally with the fibers forming a filtering matrixacross the lumen of a vessel. The integrated guide structure generallycomprises resilient elements to improve maneuverability of the distalend of the device within a patient's vasculature or other vessels, andtorque couplers can provide rotational coupling between a corewire andan overtube. Improved maneuverability can be achieved through theintegration of a torque couple with a resilient element. The fibercartridge is coupled between the corewire and the overtube such thatrelative motion of the devices functions to actuate or de-actuate thefiber cartridge. An actuation tool can be used to significantlyfacilitate the control of the relative motion of the corewire andovertube using a rotatable element, such as a dial or lever, whilereducing or eliminating the chance of kinking the delicate proximal endof the corewire.

FIG. 1A shows an embodiment of a fiber-based device 100 comprising anintegrated guiding device 102 with a fiber cartridge 104. The integratedguiding device comprises a corewire 106, overtube 108, a first resilientelement 110, a second resilient element 112, a first torque coupler 114,and a second torque coupler 116. Corewire 106 extends through a centrallumen of overtube 108 with the distal end and the proximal end of thecorewire extending from the overtube. First resilient element 110 coversa portion of corewire 106, and first resilient element 110 can extendfrom the distal end of overtube 108 or overlap with a portion of thedistal end of overtube 108. First resilient element 110 attaches nearits distal end to the proximal end of the fiber cartridge 104. Secondresilient element 112 is secured to corewire 106 at or near the distalend of the device, for example, with adhesive or by welding. Inparticular, a welded tip 118 can be placed at the distal tip of corewire106. Torque couplers 114, 116 have appropriate structure, describedfurther below, to rotationally couple corewire 106 with overtube 108 andcorewire 106 with first resilient element 110, respectively.

Referring to FIG. 1B, corewire 106 is shown separated from overtube 108,second resilient element 112 and fiber cartridge 104. Corewire 106 has afirst flattened section 126 and a second flattened section 128 that formkeyways for torque couples 114, 116, respectively. Distal segment 130 istapered, and a distal tip 132 is flattened along a portion over whichsecond resilient element 112 is placed. Weld 118 is located at thedistal tip of corewire 106. In some embodiments, corewire 106 can haveone or more deliberate notches, such as in the proximal half of thecorewire, to provide for a controlled slight amount of friction betweenthe corewire and overtube.

The resilient elements provide segments of greater flexibility relativeto the overtube flexibility. It is desirable for the distal end of thefiber-based device to have greater flexibility for navigating bends andbranches along the vessels. In general, a resilient member has anoverall tubular shape with a central lumen for the passage of thecorewire. In general, the increased flexibility of the resilient memberis achieved through a structure that lacks a solid uniform wall. Also,decreasing the wall thickness at or near the distal end providesincreased flexibility. For example, the wall thickness can be machineddown, and a polymer jacket, such as a heat shrink polymer, can be placedover the thinned wall to maintain an approximately uniform outerdiameter as well as smoothing out potential edges. For example,resilient elements can comprise a coil and/or the tube with a coilpattern or slots cut into and/or through the tube. While flexibility isdesired in the resilient section, elongation and stretching are notdesired. Also, it is desired that the resilient elements have aconstruction such that torsional force can be transferred withoutsignificant loss along the length of the section. The transfer oftorsional force enhances steerability of the tip and maintains any twistthat has been imparted into the fiber cartridge. As a result, if a coilor other appropriate resilient structure is used, the resilient elementcan be rotationally locked to a portion of the corewire such as bycreating circumferential mechanical interference between the twomembers.

As shown in FIG. 1A, second resilient member 112 is a coil that issecured between fiber cartridge 104 and weld 118. In alternativeembodiments, the coil can be replaced with a portion of cut tubing or acombination of cut tubing and one or more coil(s). Similarly, firstresilient member 110 can be a coil secured between fiber cartridge 104and overtube 108. Resilient member 110 can be attached directly, orindirectly with a spacer or the like, to the distal end of overtube 108,or resilient member 110 can overlap with a portion, such as a taperedportion, of overtube 108. As with second resilient member 112, firstresilient member 110 can comprise cut tubing or a combination of cuttubing and one or more coils, as an alternative to a coil.

The inner diameter of the resilient members should be at least largeenough to accept the corewire. The outer diameter generally is similarto the outer diameter of the overtube. A person of ordinary skill in theart can select the dimensions and elasticity of the coil to yielddesired degrees of flexibility. A particular embodiment of cut tubingsuitable to replace a coil, especially for first resilient member 110,is shown in FIG. 2A. Referring to FIG. 2A, resilient member 140comprises a first section 142 with cut slots and a second section 144with a spiral cut, which then has characteristics similar to a coil.Referring to FIG. 2B, first section 142 comprises pairs of opposingslots 146 are cut through the tube with rails 148 connecting theopposing slots. Pairs of adjacent opposing slots are rotated about 90degrees relative to each other. The dimensions and spacing of the slotscan be selected to achieve desired resiliency. As shown in FIG. 2B,resilient member 140 is cut into overtube 150 such that they areintegral members of the structure. Referring to FIG. 2C, second section144 has a spiral cut. The spiral cut provides for a slight expansion ofthe inner diameter to insert a short tube of a fiber cartridge withinthe inner diameter of second section 144. In some embodiments, firstsection 142 generally can be many inches long, while second section 144,can be a fraction of an inch in length.

Suitable cutting techniques for cutting an overtube include, forexample, mechanical cutting, electrostatic discharge machining (EDM),cutting with high pressure fluids, chemical etching and laser cutting.Laser cutting can be particularly efficient for the formation of asignificant number of precision cuts using automated control, especiallycuts that penetrate through the catheter/tube to the inner lumen.Etching may be particularly effective to form slots that do notpenetrate through the material of the overtube.

Further detail on resilient members are disclosed in published U.S.patent application 2006/0200047A to Galdonik et al., filed Mar. 4, 2005,entitled “Steerable Device Having A Corewire Within A Tube andCombination With A Functional Medical Component,” which is incorporatedherein by reference.

The length of overtube 104, e.g., a hypotube or a polytube, cangenerally be selected for the particular application. For example, forintervention in the aorta, the overtube generally would have a lengthfrom about 190 cm (63 inches) to about 300 cm (106 inches). The crosssection of the overtube can be characterized by an inner diameter and anouter diameter. The inner diameter general ranges from about 0.001inches to about 0.01 inches, in further embodiment from about 0.003inches to about 0.008 inches and in additional embodiments from about0.005 inches to about 0.007 inches. The outer diameter generally rangesfrom about 0.04 inches to about 0.009 inches, in further embodimentsfrom about 0.03 inches to about 0.010 inches, in additional embodimentsfrom about 0.02 inches to about 0.011 inches and in other embodimentsfrom about 0.015 inches to about 0.013 inches, with standard guidewireouter diameters being about 0.014 inches. The corewire has a diameterjust slightly less than the inner diameter of the tube by about 0.001inches to about 0.003 inches. A person of ordinary skill in the art willrecognize that additional ranges within the explicit ranges for thediameters are contemplated and are within the present disclosure.

In general, corewire 102, overtube 104 and resilient elements 106, 108can be formed from one or more of various materials, such as polymers,metals and combinations thereof. The overtube and corewire may or maynot be formed from the same material. Suitable materials are generallybiocompatible in that they are non-toxic, non-carcinogenic and bloodcompatible and do not induce hemolysis or a significant immunologicalresponse. Suitable biocompatible metals include, for example, titanium,cobalt, stainless steel, nickel, iron alloys, cobalt alloys, such asElgiloy®, a cobalt-chromium-nickel alloy, MP35N, anickel-cobalt-chromium-molybdenum alloy, and Nitinol®, a nickel-titaniumalloy.

Suitable polymers include, for example, synthetic polymers as well aspurified biological polymers and combinations thereof. Suitablesynthetic polymers include, for example, polyamides (e.g., nylon),polyesters (e.g., polyethylene teraphthalate), polyacetals/polyketals,polyimide, polystyrenes, polyacrylates, vinyl polymers (e.g.,polyethylene, polytetrafluoroethylene, polypropylene and polyvinylchloride), polycarbonates, polyurethanes, poly dimethyl siloxanes,cellulose acetates, polymethyl methacrylates, polyether ether ketones,ethylene vinyl acetates, polysulfones, nitrocelluloses, similarcopolymers and mixtures thereof. Based on desirable properties andexperience in the medical device field, suitable synthetic polymersinclude, in particular, polyether ether ketones, polyacetals, polyamides(e.g., nylons), polyurethanes, polytetrafluoroethylene, polyesterteraphthalate, polycarbonates, polysulfone and copolymers and mixturesthereof.

In other embodiments, the surface of the corewire, the inner surface ofthe overtube, the outer surface of the overtube, portions thereof orcombinations thereof is coated with a friction reducing agent. Suitablefriction reducing agents include, for example, suitable polymers, suchas polytetrafluorethylene, i.e., Teflon® or a polymer coating such asparylene. The coating of the corewire or a portion thereof canfacilitate relative longitudinal motion of the corewire relative to theovertube.

Torque Couplers

Torque couplers generally provide at least temporary torque couplingbetween a corewire and an overtube of an integrated guide structurewithout preventing at appropriate times a desired amount of relativelongitudinal motion of the overtube and the corewire. Various designs oftorque couplers can accomplish this objective. In embodiments withouttorque coupling, due to the very thin nature of the components of theintegrated guiding device, torque applied at the proximal end can fadeas a result of components being twisted, such that the amount ofrotation at the distal end is less than desired relative to the rotationat the proximal end. The corewire, tube, and resilient element cancontribute to an integrated guiding device with a small cross section,producing poor transfer of torque from the proximal end to the distalend of the corewire. However, by coupling the rotational motions ofthese components, the rotation of the distal end of the corewire can bebetter controlled in the coupled system upon rotating the tube at theproximal end.

In some embodiments the rotational coupling extends along the entirelength of the tube. However, in further embodiments, the rotationalengagement provided by a torque coupler can be constrained forconvenience to localized regions such as at or near the distal end ofthe overtube, at or near the proximal end of the overtube, and/or in thecentral region of the overtube. Generally, it is advantageous to couplethe tube and corewire in a distal-most region if the desired goal isefficient transfer of torque to the distal tip. In particular, it can bedesirable to have rotational coupling between the overtube and thecorewire within twenty centimeters of the distal end of the corewire,and in some embodiments, within about four centimeters from the distalend of the overtube.

Furthermore, additional rotational coupling provided by additionaltorque couplers can further improve torque transmission to the distalend of the corewire. In particular, it has been found to be advantageousto provide a torque coupler integrated with a resilient memberassociated with and extending from the distal end of the overtube. Sincethe resilient member can extend over a significant distance, theincorporation of a torque coupler within the resilient element providesfor the placement of a torque coupler closer to the distal end of thecorewire without correspondingly making the resilient member smaller.Surprisingly, even though the resilient element is resilient, theresilient element can be effectively adapted to form a component of atorque coupler for transmission of torque between the corewire and theresilient element, and the attachment of the resilient element to theovertube further provides rotational coupling among the various elementsof the fiber-based device. For resilient members that are a coil, it canbe desirable to fuse some of the turns of the coil together at thetorque coupler, which does not significantly change the resilient natureof the element while stabilizing the function of the torque coupler. Inone particular embodiment, an approximately 2/25 mm section of a coil isfused with a laser at the location for the formation of the torquecouple, although other segment lengths can be selected as long as theflexible nature of the coil is not significantly changed and othertechniques can be used to fuse a section of the coil at the torquecoupler.

Torque couplers are generally formed by components of the integratedguiding device engaging with each other. In some embodiments, thecomponents engage by the mechanism of a protrusion fitting within adepression. Specific torque coupling embodiments are shown in FIGS. 1, 3and 4. FIG. 1A shows an assembled fiber-based device 100 comprising anintegrated guiding device with portions of torque couplers 114, 116shown as indentations or notches 120, 130 in overtube 104 and firstresilient element 116, respectively. These indentations 120, 130 formkeys or key-like structures which engage with the flattened keywayportions 126, 128 formed in the corewire 102 as shown in FIG. 1B.

Referring to FIG. 3A, first torque coupler 114 rotationally couplescorewire 106 with overtube 108. The walls of overtube 108 comprise anindentation 120 on the outer surface defining a downward protrusionalong the inner diameter that fits into flattened keyway portion 126 onthe outer surface of corewire 106. The length of keyway 126 specifieslimits on the relative longitudinal motion of the corewire relative tothe overtube. FIG. 3B shows a sectional view of the integrated guidingdevice taken along torque coupler 114, which is shown as flattened areasinterfacing each other due to structure from indentation 120 andflattened portion 126. As a comparison, FIG. 3C shows a sectional viewof the integrated guiding device taken along an area outside torquecoupler 114. One of ordinary skill in the art would recognize thatovertube 108 and corewire 106 can have different shapes for the crosssectional interface regardless of whether the sectional view is taken atthe torque coupler or at an area outside the torque coupler.

Referring to FIGS. 4A-4C, expanded sectional views are displayed forsecond torque coupler 116. Referring to FIG. 4A, torque coupler 116rotationally couples the corewire 106 with resilient element 110. If theresilient element 110 comprises a coil, a section of coil has anindentation 130 defining a downward protrusion along the inner diameterof the coil that fits into flattened keyway portion 128 of corewire 106.The coil covers a section of corewire 106, extending from roughly thedistal end of the overtube 108 to roughly the proximal end of the fibercartridge 104.

Regardless of whether the resilient element comprises a coil or a cutportion of the overtube, the resilient element is shaped to provide aprotrusion that engages with a flattened segment formed in the corewire.The length of flattened keyway portion and the size of the key furtherconstrains the range of lateral motion of the corewire relative to theovertube available without damaging the device, although the fibercartridge may also provide constraints on the extent of relative lateralmotion. FIG. 4B shows a fragmentary sectional view of the integratedguiding device taken through torque coupler 116. Torque coupler 116 hasflattened areas engaging each other as a result of the structure ofprotrusion 130 and flattened portion 128. As a comparison, FIG. 4C showsa sectional view of the integrated guiding device taken along an areaoutside torque coupler 116 along resilient member 110. In contrast tothe semi-circular cross section of the corewire in FIG. 4B, thesectional view taken outside torque coupler 116 has a circularcross-section. One of ordinary skill in the art would recognize thatcoil 106 and corewire 102 can have different cross sectional shapes aslong as the elements are mated to engage properly while providing forsome relative lateral movement. There are significant advantages tohaving a torque coupler interfaced with the resilient member. While theresiliency of the resilient member affords the flexibility to providefor the steering of the fiber-based device, it also causes the resilientmember to distort in shape, which decreases the torque transfer from theproximal end to the distal end of the fiber-based device. A torquecoupler interfacing the resilient member with the corewire wouldrotationally couple the resilient member with the corewire to decreasedistortion of the resilient member around the corewire and increase thetransfer of torque from the proximal end to the distal end of thecorewire. Surprisingly, the resiliency of the resilient member does notdetract from the ability to function as a torque coupler.

A variety of alternative structures are possible for torque couplers inaddition to the lock and key embodiments discussed specifically above.Some alternative embodiments are described in more detail in publishedU.S. patent application 2006/0200047A, filed Mar. 4, 2005 to Galdonik etal., entitled “Steerable Device Having A Corewire Within A Tube andCombination With A Functional Medical Component,” which is incorporatedherein by reference.

Fiber Cartridges for Use with Integrated Guiding Device

In general, a fiber cartridge can be combined with an integrated guidingdevice, to facilitate delivery of a fiber-based element on a structurethat provides for delivery of additional treatment devices, such as anangioplasty balloon or a stent delivery device, over the guidestructure, which function sin this regard similar to a guidewire. Thefiber cartridge can be actuated through the relative longitudinal motionof the corewire and the tube. Generally, the fiber cartridge is locatedat or near the distal end of the integrated guiding device with controlof actuation being provided at the proximal end of the device. Inembodiments of particular interest, the fiber cartridge comprises afibers connected at their respective ends to two separate short tubes.The inner diameter of the short tubes is selected such that the corewirecan pass through the central lumen of the short tubes. For deployment, abundle of the fibers can be in a stacked linear configuration with theshort tubes spaced apart such that the fiber bundle has a small profile.Upon deployment, the short tubes are pulled together such that thefibers flare outward from roughly their center to form a filtrationmatrix across the diameter of the vessel. In some improved embodiments,the short tubes comprise a radiopaque material and are configured totouch or overlap in the deployed configuration to improve visualizationof the fiber cartridge deployment during a procedure. Alternatively oradditionally, other radiopaque structures or materials, such as anadhesive with a radiopaque composition, can be associated with the fiberends within the fiber cartridge.

Fibers with non-circular cross sections, e.g., oval, are particularlydesirable for use in fiber cartridges. In particular for appropriateembodiments, while not wanted to be limited by theory, it is believedthat non-circular fibers pack into a filtration matrix with improvedfiltration capability with respect to collecting particles with a rangeof particle sizes while maintaining good flow through the filter evenwhen the filter has captured debris within the vessel. In particular,fibers with surface capillary fibers can be effectively used infiber-based devices for filtering applications. Fibers with surfacecapillaries have a non-circular cross section with a more complexgeometry. Filters formed with surface capillary fibers have been foundto have excellent performance in clinical use, as has been demonstratedin clinical trials with the Fibernet® device from Lumen Biomedical Inc.

Referring to FIGS. 5 and 6, an embodiment of a fiber cartridge 151comprises a bundle of fibers 152, a first tube 154 and a second tube156. Fiber bundle 152 has a first bonded end 158 bonded to the outersurface of first tube 154 and a second bonded end 160 bonded to theouter surface of second tube 156. Optionally, a first outer band 162surrounds at least a portion of first bonded end 158, and/or a secondouter band 164 surrounds at least a portion of second bonded end 160.The center of the fiber bundle remains unconstrained such that thefibers can flare outward upon deployment. If the fibers comprise athermoplastic material, the ends of the fibers can be melt bonded tosecure first bonded ends 158, 160 to tubes 154, 156, respectively.Additionally or alternatively, an adhesive can be applied at firstbonded end 158, 160 to contribute to the bonding of the fibers togetherat the ends as well as to bond the fiber ends to the tubes.

In some embodiments, first tube 154 extends from both ends of firstbonded end 158, and second tube 156 extends from both ends of secondbonded end 160. In these embodiments, a section of tubes 158, 160extends into the portion of the fiber cartridge with unbound fibers. Theportion of the tubes extending longitudinally outward from the fibercartridge can be used to secure the fiber cartridge within thefiber-based device as described further below. Tubes 158, 160 shouldhave an inner diameter larger than the diameter of the corewire of thefiber-based device such that fiber cartridge 150 can be loaded over thecorewire for incorporation into the fiber-based device.

During deployment of fiber cartridge 151, first bonded end 158 andsecond bonded end 160 are drawn toward each other on the corewire, asshown in FIG. 7. When tubes 158, 160 move toward each other, the bundleof fibers flare into a three dimensional filtration matrix 170 having aconfiguration to catch emboli, as shown in a fragmentary view in FIG. 7.The tubes 154, 156 can have different inner and outer diameters toenable one of the tubes to be inserted within the other tube whenbrought together. In some embodiments, the tubes have a tipconfiguration to provide for relative insertion that is different fromthe diameter or shape of the remaining portion of the tube, although thetube diameter can be constant. The bundle of fibers can flare generallyto fill the lumen of the vessel in which the fiber-based device isinserted. When one or both of the tubes move away from the other, thebundle of fibers reverts to a lower profile retrieval configurationapproximating the initial bundle configuration prior to deployment.

First tube 158 and second tube 160 can be made of radiopaque material toprovide observation of the tubes when they are inside the lumen of thebody vessel. The radiopaque material allows the tube(s) to be observedusing electromagnetic radiation, such as x-ray. Suitable radiopaquematerials are discussed above. Thus, for embodiments in which tubes 158,160 engage following proper deployment, the configuration of the fibercartridge can be checked within the patient. This is especially helpfulin determining whether the fibers are in a properly deployedconfiguration prior to continuing with the procedure in the vessel. Ifx-ray observation reveals that the image of the tubes overlap, then thefiber cartridge has been deployed the desired amount. If x-rayobservation reveals that tubes are away from each other, then the fibercartridge is not in the desired deployed configuration, and thephysician can attempt to correct the deployment prior to continuing withthe procedure. If the procedure is continued with the fiber cartridgenot deployed in the proper configuration, then emboli generated in theprocedure can more likely escape past the deployed fiber cartridge intothe down stream narrowing blood vessels.

It can be difficult to judge the distance between the tubes throughx-ray observation, especially during the pressures of procedure. Thus,by making one of the tubes insertable within the other tube, a physiciancan proceed with confidence in the x-ray observation of the device withthe tube merged into a single image, and the chance of error during theprocedure can be significantly reduced with a corresponding improvementin the cumulative outcomes of the procedures. Since these devices can beused in significant vessels such as coronary arteries, carotid artiesand smaller arteries of the brain, diminishing the chance of embolimigration that can result in infarctions provides a significant advancein patient care.

The transition of the fiber cartridge from a delivery configuration tothe deployed configuration is shown in FIGS. 8A and 8B, for afiber-based device 170 similar to the fiber-based device 100 of FIG. 1.Referring to FIGS. 8A and 8B, fiber-based device 170 comprises corewire172, overtube 174, proximal resilient member 176, fiber cartridge 178,distal resilient member 180 and distal tip 182. Fiber cartridgecomprises proximal bonded end 184, distal bonded end 186 and fiber-basedelement 188. The relative motion of corewire 172 and overtube 174 can beused to deploy the fiber cartridge from a confined narrow profileconfiguration with the fibers in an aligned bundle for delivery (FIG.8A) to a deployed configuration at which the filter cartridge isextended radially relative to the axis of the device with the fibersflared out into a fiber matrix, such as a filter matrix, within thevessel (FIG. 8B).

With respect to the fiber bundle, the number of fibers in the bundlegenerally depends on the desired degree of filtration as well as thethickness of the fibers. In general, the number of fibers can be rangefrom at least 10 fibers, in further embodiments from 25 fibers to1,000,000 fibers, in other embodiments from 50 fibers to 10,000 fibersand in additional embodiments, from 100 fibers to 5,000 fibers. Thelength of the fibers can be selected based on the size of thecorresponding vessel. When deployed, the centers of the fibers areprojected across the lumen of the vessel. Thus, the unconstrained lengthof the fibers between bonded ends 158, 160 should be at least double theradius of the vessel. In some embodiments relating to the use of aplurality of fibers to expand within the lumen of a patient's vessel, itis generally appropriate to use fibers that have a length from about 2.2to about 10 times the vessel radius, in some embodiments from about 2.4to about 5 times the vessel radius and in further embodiments from about2.6 to about 4 times the vessel radius. For placement in a human vessel,the fibers generally have a length from about 0.5 mm to about 100 mm, inother embodiments from about 1 mm to about 25 mm, and in furtherembodiments from about 2 mm to about 15 mm. A person of ordinary skillin the art will recognize that additional ranges of fiber numbers andfiber length within the explicit ranges are contemplated and are withinthe present disclosure.

As used herein, SCF fibers refer broadly to fibers having channels orcapillaries along the surface running generally along the length of thefiber or a portion thereof. Fibers have their usual meaning asstructures with a length that is significantly larger than thedimensions along a cross section perpendicular to the length. Thecapillaries can run along substantially the entire length or a fractionthereof. Due to the presence of the capillaries, a cross section throughthe fiber at the capillary(ies) has a shape with an edge having changingcurvatures.

SCF fibers for use in the medical devices are generally formed frombiocompatible polymers. SCF fibers can be fabricated from syntheticpolymers as well as purified biological polymers and combinationsthereof. Suitable synthetic polymers include, for example, polyamides(e.g., nylon), polyesters (e.g., polyethylene teraphthalate),polyacetals/polyketals, polystyrenes, polyacrylates, vinyl polymers(e.g., polyethylene, polytetrafluoroethylene, polypropylene andpolyvinyl chloride), polycarbonates, polyurethanes, poly dimethylsiloxanes, cellulose acetates, polymethyl methacrylates, polyether etherketones, ethylene vinyl acetates, polysulfones, nitrocelluloses, similarcopolymers and mixtures thereof. Based on desirable properties andexperience in the medical device field, suitable synthetic polymersinclude, in particular, polyether ether ketones, polyacetals, polyamides(e.g., nylons), polyurethanes, polytetrafluoroethylene, polyesterteraphthalate, polycarbonates, polysulfone and copolymers and mixturesthereof.

Bioresorbable synthetic polymers can also be used such as dextran,hydroxyethyl starch, derivatives of gelatin, polyvinylpyrrolidone,polyvinyl alcohol, poly[N-(2-hydroxypropyl)methacrylamide], poly(hydroxyacids), poly(epsilon-caprolactone), polylactic acid, polyglycolic acid,poly(dimethyl glycolic acid), poly(hydroxy butyrate), and similarcopolymers. Based on experience in the medical field, suitableresorbable polymers include, in particular, polylactic acid,polyglycolic acid, and copolymers and mixtures thereof.

Appropriate polymers also include biological polymers. Biologicalpolymers can be naturally occurring or produced in vitro by fermentationand the like. Suitable biological polymers include, without limitation,collagen, elastin, silk, keratin, gelatin, polyamino acids, cat gutsutures, polysaccharides (e.g., cellulose and starch) and mixturesthereof. Biological polymers generally are bioresorbable. Purifiedbiological polymers can be appropriately formed into a polymer materialfor further processing into fibers.

The properties of the surface channels and the correspondingcross-section of the fiber generally depend on the process used to formthe fibers. One approach for forming a fiber with surface capillaries isdescribed in U.S. Pat. No. 5,200,248 to Thompson et al. (hereinafter the'248 patent), entitled “Open Capillary Channel Structures, ImprovedProcess For Making Capillary Channel Structures, And Extrusion Die ForUse Therein,” incorporated herein by reference. The Background sectionof the '248 patent additionally references a variety of alternativeembodiments of approaches for forming fibers with surface channels orcapillaries. Additional approaches for the formation of surfacecapillaries for use in a fiber-based devices are described in publishedU.S. Patent application 2005/0209631 to Galdonik et al., entitled“Steerable Device Having a Corewire Within a Tube and Combination With aFunctional Medical Device,” incorporated herein by reference. Any ofthese approaches can be used to form surface capillary fibers. Inparticular, the fibers formed by the process of the '248 patent itselfhave desirable characteristics and versatility. Further characterizationof the SCF fibers, such as with respect to capillary properties, canborrow from the approaches outlined in the '248 patent.

As with the fiber length, the thickness of the fibers can be selectedappropriately for the particular use of the fiber. Fiber thickness canbe measures in several ways. For example, the radius of the fiber can beroughly estimated from the assumption of a circular cross section.Alternatively, one can define an average diameter by taking an averagecross section and then averaging the length of segments through thecenter of the cross section that intersect the circumference of thecross section. Also, calipers can be used to measure thickness, whichcan be averaged to obtain a value of the diameter. These variousapproaches at estimating the radius or diameter generally give values ofroughly the same magnitude. Also, in the fiber field, a pragmatic wayhas been developed to characterize fiber thickness without the need toresort to magnification of the fibers. Thus, fiber thickness can bemeasured in units of denier. Deniers correspond to the number of gramsper 9,000 meters of yarn with a larger value corresponding to a thickerfiber. In some embodiments, suitable fibers have diameters from 50microns to about 5 millimeter, in further embodiments from about 100microns to about 2 millimeters, and in additional embodiments from about150 microns to about 1 millimeter. As measured in denier, SCF fibers canhave sizes ranging from about 0.1 denier to about 1000 denier in size,in additional embodiments from about 0.5 denier to about 250 denier, insome embodiments from about 1.0 denier to about 200 denier, in otherembodiments from about 2.0 denier to about 100 denier and in furtherembodiments from about 3.0 denier to about 50 denier. A person ofordinary skill in the art will recognize that additional ranges of fiberthickness in diameter measurements or in denier are contemplated and arewithin the present disclosure.

In general, a commercial device will have a plurality of available sizessuch that a physician can select a particular device based on the sizeof the vessel for treatment. Each size of device can be designed tooperate in vessels with a range of sizes. For example, the commercialproducts can have two sizes, three sizes, four sizes or more than foursizes. In one specific embodiment, the device comprises 480 of 6 denierSCF fibers in a bundle and a crossing profile of 0.033 inches (2.5French).

It has been found that particular preparation processes for the fiberscan lead to significantly improved uniformity of the performance of thefiber-based device. In particular, the fibers are twisted within thefiber bundle. In some embodiments, heat is also applied to the fibers.While any degree of twist can be desirable, twist can be applied to thefiber bundle of at least about 5 degrees and in further embodiments fromabout 180 degrees to about 360 degrees. Furthermore, multiple rotations,for example, about 360 degrees to about 1080 degrees, can further act toincrease the density of fibers and may be advantageous. A person ofordinary skill in the art will recognize that additional ranges of twistwithin the specific ranges above are contemplated and are within thepresent disclosure. The twist can be applied by fastening one end of thefiber bundle, applying the twist and fastening the other end of thefiber bundle. A suitable torque coupler can facilitate the applicationof the twist to the fibers since the corewire does not rotate due totension in the SCF fibers. With the application of a suitable twist, thefiber-based device is observed to perform with essentially uniformperformance. Without the application of the twist, some of the fiberdevices have been observed to have small gaps in the filtering of theflow upon deployment. Thus, the twist provides for a commercial devicewith reproducible performance expected for medical devices in practice.

Various other configurations of the embolism protection structure isdiscussed in published U.S. Patent Application. 2006/0200047 to Galdoniket al., entitled “Steerable Device Having A Corewire Within A Tube andCombination With A Functional Medical Component,” incorporated herein byreference.

Actuation Tool

Improved actuation tools described herein provide for proper deploymentof the fiber-based device while simultaneously providing ease of use fora physician. Because the fiber cartridge structure can serve animportant purpose of preventing emboli from traveling away from atreatment site, it is especially significant for proper function thatthe structure is deployed properly. Actuation tools can be speciallydesigned to longitudinally move the corewire relative to the tube bygripping and moving the proximal ends of the corewire and tube towardand away from each other to deploy and collapse the fiber cartridge. Animproved actuation tool comprises a rotatable element, such as a leveror dial, to change the relative longitudinal position of corewire andthe overtube. The rotatable element format is both easier to handle anduse as well as avoiding any confusion with respect to direction ofmovement to transition the fiber cartridge. In particular, it was foundwith linear translating tool that intuitively to deploy the fibercartridge physicians wanted to push the corewire into the vesselrelative to a fixed overtube, which is the opposite of the correctmotion. For embodiments in which the rotatable element is a lever, thearm of the lever can be placed within a housing so that the visibleportion of the rotatable element is a tab or handle that rotates aroundan arc.

Referring to FIGS. 8A and 8B, corewire 172 is pulled in a proximaldirection relative to overtube 174 to deploy fiber cartridge 178 bybringing first fixed end 184 toward second fixed end 186. Furthermore,the dial can be interfaced with suitable locks to prevent prematuredeployment of the fiber cartridge as well as locking the fiber cartridgeinto a deployed configuration while the procedure is underway. The dialcan be straightforwardly replaced with a lever that points to the sameposition as a position mark on the dial.

For the actuation tool to function properly, the corewire and overtubeshould be properly loaded into the tool. Actuation tool designsdescribed herein provide a stop to indicate that the overtube has beenproperly loaded such that the overtube can be locked into positionwithin the tool. Correspondingly, the actuation tool can include aviewing area, such as a window, to show that the corewire is loadedwithin acceptable limits with respect to the properly loaded overtube.Once the corewire is observed within the viewing area, the corewire canbe locked into position in the actuation tool. The viewing area can be awindow with or without a transparent cover, or just a position extendingfrom the device that provides visualization of the end of the corewireso that observation of the corewire in the viewing area signals that thecorewire is appropriately inserted. The corewire is very thin, and cankink easily even if unsupported for even a very short distance. Kinkingof the corewire can damage the device in the middle of a procedure withgenerates undesirable risk to the patient. As described herein, theactuation tool is designed such that no more then about 0.050 inches andin some embodiments no more than about 0.025 inches of the corewire isunsupported by a selected clearance. In some embodiments, the clearancebetween the corewire and the support structure within the tool is nomore than about 0.010 inches, and in further embodiments no more thanabout 0.0050 inches, and in additional embodiments is no more than about0.0025 inches. This support can use interconnected elements within thetool such that the wire remains supported at different longitudinalpositions relative to the corewire. A person of ordinary skill in theart will recognize that additional ranges of dimensions relating tosupport of the corewire within the explicit ranges above arecontemplated and are within the present disclosure.

Referring to FIG. 9, an actuation tool 200 comprises a support structure202, a corewire connection 204 and an overtube connection 206 eachconnected to opposite ends of the support structure 202, a dial 208, anda button lock 210. Corewire connection 204 and overtube connection 206interface with support structure 202 along a channel 220 that providesfor passage of the corewire, as shown in FIG. 11. Corewire connection204 and tube connection 206 are gripping devices that respectively gripthe corewire and overtube when engaged to provide for their relativelongitudinal movement through rotation of dial 208.

Referring to FIGS. 9-11, in this embodiment, corewire connection 204 andovertube connection 206 are collets that comprise, respectively,threaded receiving sleeves 222, 224 and mated threaded caps 226, 228.Receiving sleeves have a taper and one or more slits such that channelsthrough the receiving sleeves shrink in diameter when the mated cap istightened such that the respective collets grip the overtube or corewireupon tightening. As shown in FIG. 11, sleeve 222 is integral with arm238 that is securely attached to housing 202. Cap 226 can comprise awindow 240, as shown in FIG. 9, for observing the corewire, such that itcan be quickly determined if the corewire is properly loaded in theactuation tool. Referring to FIG. 11, corewire tubular channel 241 isconnected to sleeve 222 to form a continuous corewire path into cap 226.Sleeve 224 is connected to sliding arm 242. Sliding arm 242 has anovertube channel 244, an overtube stop 246 that provided a limit on theinsertion of the overtube with a corewire tubular channel 248 connectedto sliding arm 242 extending beyond the overtube stop. Corewire tubularchannel 248 has an inner diameter slightly larger than the outerdiameter of corewire tubular channel 241 so that corewire tubularchannel 248 slides over corewire tubular channel 241 when sliding arm242 moves such that the corewire is supported essentially along itsentire length within actuation tool 200.

While the embodiment shown in FIGS. 9-11 is based on collets, corewireconnection 204 and overtube connection 206 can be based on otherdesigns. For example, connections 204, 206 can comprise clamps that snapbetween locked and unlocked configurations, in contrast with the colletsthat screw into position. In some embodiments, a lever arm can be usedto transition the connections between locked and unlocked positions.Various clamps designs in the art can be adapted as substitutes for thecollets based on the disclosure herein.

Referring to an exploded view in FIG. 10 and a cut away exposed view inFIG. 11, the components internal to the support structure 202 comprisesa control element that moves the corewire connection and the tubeconnection away from and toward each other to move the corewire and tubeaway from and toward each other, respectively. Referring to FIG. 10,support structure 202 comprises housing 250 and cover 252 that attachedto housing 250 to cover the moving parts within housing 250. The controlelement can include a transmission comprising gear 254 that interfaceswith sliding arm 242 such that rotation of gear 254 is converted totranslation motion of sliding arm 242 such that the position of corewireconnection 204 and overtube connection 206 can be adjusted. Inparticular, gear 254 and sliding arm 242 comprise teeth that cooperatewith each other. Gear 254 is operably connected to a knob 256 thatconnects with dial 208. When dial 208 is rotated, gear 254 rotates withthe dial 208 and the gear's teeth cooperate and move with the teeth ofsliding arm 242 to convert the rotational movement of the dial 208 andgear 254 to translational movement of sliding arm 242 to move corewireconnection 204 relative to tube connection 206. Other transmissiondesigns for converting rotational motion of the rotatable element to atranslational motion of the corewire connection or the overtubeconnection can replace the design shown in FIG. 11 if desired.

Cover 252 comprises a first hole 258 for the passage of a portion ofknob 256 to provide for connection to dial 208 and a second hole 260 forthe passage of depressible button 210. Cover 252 can further comprisemarkings 262 to provide instructions. Dial 208 comprises a notch 270that engages with safety button 210 at a particular rotation of dial 208to prevent rotation of the dial 208 unless the safety button 210 isdepressed. Safety button 210 can be constructed with a spring, such as aconventional spring structure or the like, or with other elasticmaterial or appropriate construction. In some embodiments, notch 270 ispositioned to engage safety button 210 at a dial position correspondingwith the deployed configuration of the fiber cartridge correspondingwith a particular relative position of the corewire and overtube. Asshown in FIG. 10, actuation tool 200 can be supplied with a removableshipping lock 272 that interfaces with dial 208 and cover 252 to supplythe dial at a particular orientation. Shipping lock 272 can be kept inposition until the fiber-based device is placed within the patient andthe operator is ready to deploy the fiber cartridge. Shipping lock 272can be removed to deploy the fiber cartridge or other element within thepatient. In alternative or additional embodiments, a second depressiblebutton or the like can be used to hold dial 208 at a delivery positionto resist premature deployment of the device. Furthermore, otherappropriate locking features, such a frictional catch or the like, canreplace the button lock to provide fixed positions of the dial at thedeployed and/or delivery positions of the dial.

Referring to FIG. 11, a cut away exposed view of actuation tool 200reveals the components internal to sliding arm 242 and arm 238. Arm 238has a projecting sleeve 274 that extends within sliding arm 242 tofacilitate the sliding motion of sliding arm 242 while keeping thechannel aligned for the corewire. The clearance between the adjustablecorewire channel 248 and the corewire can be less than or equal to about0.003 inch. Adjustable corewire channel 248 can provide appropriatesupport for the entire length of the corewire exposed from the overtubethrough the locked position within the corewire connection 204. In someembodiments, adjustable corewire channel 248 extends to leave less thanabout 0.001 inch of the corewire unsupported between the position atwhich the corewire exits the overtube and the locked position incorewire connection 204.

In operation, actuation tool 200 is constructed to actuate or de-actuatethe fiber cartridge by taking an advantage of the configuration of theintegrated guiding structure with the proximal end of the corewireextending from the proximal end of the tube. The proximal end of thecorewire is inserted through overtube connection 206 and adjustablecorewire channel 248 into the corewire connection 204. The overtubecontacts stop 246 to indicate full insertion of the overtube intoovertube connection 206. The user can observe the corewire withinobservation window 240 to confirm that the corewire is properlypositioned within the corewire connection 204. After the corewire isproperly positioned corewire connection can be locked onto the corewire,and overtube connection can be similarly locked onto the overtube eitherbefore or after locking the corewire connection. Safety lock 272 can beremoved to rotate dial 208 to deploy the fiber cartridge or otherdevice, and dial 208 is rotated until button 210 extends outward toengage notch 270 to lock the device in the deployed configuration. Whendial 208 is rotated clockwise, gear 254 also rotates clockwise andcauses translational movement of sliding arm 242 away from corewireconnection 204, which increases the length of adjustable channel 248which brings the tubes of the fiber cartridge toward each other to flarethe fibers. When dial 208 is rotated counterclockwise upon depressingbutton 210, gear 254 also rotates counterclockwise and causestranslational movement of sliding arm 242 toward corewire connection204, which decreases the length of adjustable channel 248 to transitionthe fiber cartridge to a lower profile recovery configuration. Theactuation tool can be temporarily removed for the loading of otherinstruments over the integrated guide structure.

An alternative embodiment of an actuation tool is shown in FIGS. 12-15.This tool is designed to grip the overtube and corewire simultaneouslywith two gripping elements, respectively. Referring to FIGS. 12-15,actuation tool 400 comprises a housing 402, a wire entry port 404,loading window 406, a wire release element 408 and an actuation dial410. Housing 402 has an ergonomic design to facilitate use. Wire entryport 404 has a funnel shape to facilitate insertion of an integratedguide structure 414 into the opening 416. The internal channel for theovertube and core wire can be essentially as described above for FIGS.9-11 within housing 402. Thus, the corewire is appropriately supported,and the corewire can be moved relative to the overtube for actuationpurposes. Window 406 is formed from a transparent material, such as aplastic or glass material. This tip of the corewire 418 can be observedin window 406 to confirm proper loading of the corewire within the tool.

Wire release element 408 comprises a button that is depressed to unlockinternal gripping elements to provide for insertion of the overtube andcorewire into the guide channel within housing 402. The depression andrelease of button 408 can be controlled with one or more suitablesprings or the like. To control the opening of the internal grippingelements, depression of button 408 can shift a moveable section of awall along the guide channel to provide a suitable opening for theovertube of one gripping element and for the corewire at the othergripping element. Upon release of the button, the moveable section ofthe gripping element translates to grip the respective overtube orcorewire. In alternative embodiments, button 408 can be replaced with alever or other moveable element that can be translated to lock andunlock the gripping elements.

Actuation dial 410 can function similarly to dial 208 in FIG. 9.Referring to FIGS. 12-14, dial 410 can be locked unless the centralbutton 420 is depressed. In alternative embodiments, housing 402 cancomprise buttons at adjacent positions to the dial to unlock the dialfrom the actuated or un-actuated positions. Similarly, dial 410 cancomprise an alignment feature 422 for visualization of the status of thetool in which the housing has corresponding alignment features 424, 426,428 to indicate correct positioning for actuation and un-actuating thedevice controlled with the guide structure inserted into the tool.

Another alternative embodiment for the actuation tool is shown in FIGS.16 and 17. The embodiment of FIGS. 16 and 17 is similar to theembodiment in FIGS. 12-15 except for the function of the locking andunlocking the gripping element. Referring to FIGS. 16 and 17, actuationtool 440 comprises a housing 442, a loading funnel 444, a viewing window446, a lift cover 448, and an actuation dial 450. Lift cover 448replaces button 408 in the embodiment of FIGS. 12-15. Referring to FIGS.16 and 17, lift cover 448 has a closed position in which cover 448 isenclosed. When lift cover 448 is closed, then gripping elements are openso that the integrated guide structure can be inserted through loadingfunnel 444 into housing 442. Referring to FIG. 17, cover 448 opens to anactuation position where the cover snaps into position to expose dial450. Placement of cover 448 in the actuation position locks the overtubeand corewire in position within housing 442. Then, with accessavailable, dial 450 can be rotated between an initial position 452 and adeployed/actuated position 454 and then from an actuated position 454 toan un-actuated position 456. Un-actuated position 456 can be the sameposition or a different position from initial position 452. Inparticular, it can be desirable to have the un-actuated position toextend beyond the initial position, as shown in FIG. 17, to placeadditional tension on the fiber bundle to place the device in a desiredconfiguration for removal from the patient. Thus, to load a tool such asan aspiration catheter or a stent delivery catheter over the integratedguide structure, cover 448 can be placed in the closed position torelease the integrated guide structure, which is then disconnected fromthe actuation tool for loading of the catheter and then replaced intothe actuation tool. While the integrated guide structure is disconnectedfrom the actuation tool, the dial cannot be accidentally rotated sinceit is covered.

Aspiration Catheter

The aspiration catheters described herein can be effectively used alongwith fiber-based devices, such as those described herein, or in separateprocedures within a patient. The aspiration catheters generally have arapid exchange construction, such as a single lumen rapid exchangedesign. The catheter can comprise a polymer material that is reinforcedwith metal wire or the like to balance mechanical strength andflexibility. Radiopaque marker bands can assist with visualization whenthe catheter is within a patient. It has been discovered that coveringthe radiopaque marker bands with the reinforcing metal wire prior toembedding the metal wire into the polymer can significantly decrease thechance of catching the marker bands on structure within the patient. Ifthe marker bands catch on structure within the patient, such as a stentor anatomical structure, it can make it difficult to remove theaspiration catheter, the vessel within the patient can be damaged,and/or the marker bands can be disengaged from the catheter within thepatient. In some embodiments, a narrow diameter extension can extendfrom the distal end of catheter to provide access into smaller vessels,such as blood vessel in the brain, such that the catheter can reach morelocations while still providing desirable amounts of suction.

Referring to FIGS. 18 and 19, in a particular embodiment aspirationcatheter 300 comprises a hollow tube 302, a rapid exchange segment 304with a bent tip 306 and with a distal aspiration port 308 and a fitting310 for attachment to a suction device, which is shown as a female Luerfitting. In some embodiments, a single lumen extends from fitting 310through tube 302, through rapid exchange segment 304 to distalaspiration port 308. While it can be desirable for tube 302 to have asingle lumen, in alternative embodiments tube 302 can have a pluralityof lumen, such as two, three or more lumen, in which the lumen may ormay not have different functions in the device. Fitting 310 comprises ahandle 312 and a connection port 314.

A guidewire port 320 is located at the position at which rapid exchangesegment 304 joins tube 302, as shown in FIGS. 18 and 18A. Rapid exchangesegment 304 may or may not have a larger average diameter than tube 302.As shown in FIGS. 18, 19 and 19A, the rapid exchange segment has alarger diameter than the adjacent tube. The use of a larger diameterrapid exchange segment provides for easier entry of a fiber cartridgeinto the aspiration catheter for removal from the patient with lessdisruption of flow along the length of the catheter when the catheter isdelivered into smaller blood vessels.

To facilitate observation of the catheter by x-ray when the catheter iswithin a body, one or more radiopaque bands can be positioned on thetube. Furthermore, visual marker bands can be placed near the proximalend of the aspiration catheter for evaluating the position along thefiber-based device for the portion of the devices outside from thepatient. FIGS. 18, 18B, 19 and 19B show a first radiopaque band 322positioned at the distal tip of the catheter, and a second radiopaqueband 324 positioned at a selected position on rapid exchange segment304. Visual marker bands 326, 328 are also shown in the embodiment ofFIGS. 18 and 19.

The catheter can have sufficiently small diameters for entry into smallarteries of the brain or other small vessels. In particular, in someembodiments, the rapid exchange segment or a portion thereof can have asmaller diameter than the average diameter of the tube. Referring toFIG. 20, aspiration catheter 350 for accessing smaller vessels comprisesa tube 352, a rapid exchange segment 354, a rapid exchange port 356 atthe position at which rapid exchange segment joins tube 352 and areduced diameter distal segment 358 with an average diameter smallerrelative to the average diameter of the tube with a curved distal tip360 having a radiopaque marker band 362. While the proximal end ofcatheter 350 is not shown in FIG. 20, catheter 350 can have fittingssimilar to those shown in FIGS. 18 and 19 or other suitable fittings.While FIG. 20 shows distal segment 358 including only a portion of rapidexchange segment 354, in other embodiments a rapid exchange port islocated adjacent the distal segment such that the rapid exchange segmentis the same as the distal segment.

Distal segment 358 can have an outer diameter from about 25 percent toabout 95 percent of the average outer diameter of the tube of thecatheter, and in further embodiments from about 45 to about 90 percentand in additional embodiments from about 60 to about 85 percent of theaverage diameter of the tube. For example, the distal tip can have anouter diameter range from about 0.015 to about 0.120 inches, and thetube can have an outer diameter range from about 0.030 to about 0.150inches, in other embodiments from about 0.040 to about 0.125 inches andin further embodiments from about 0.045 to about 0.120 inches. A personof ordinary skill in the art will recognize that additional ranges ofdimensions within the explicit ranges above are contemplated and arewithin the present disclosure.

As shown in FIGS. 18, 19 and 20, the distal tip can also be bent orcurved to provide improved tracking during delivery into a patient'svessel by controlling tracking along a guide structure extending fromthe tip. The curved tip facilitates tracking of the catheter along theguide structure with a reduced tendency of the catheter to redirect theguide structure at branches or curves in the vessel. The guide structuredeflects the bent tip such that the guide structure at least partiallyguards the opening of the aspiration catheter during the delivery of theguide catheter through the patient's vessel. The curved tip deflects thesharp edge of the tip away from the vessel wall and naturally tracksalong the guide structure with little drifting since the curve creates atight transition from the wire to the catheter on one side of the curve.The tip opening presents a small profile for snagging and tracks closelyalong the path of the guide structure as it is pushed along the guidestructure. Optionally, the tip is provided with a beveled edge.

The angle of the curved tip relative to a straight tip generally is lessthan 90 degrees and can be, for example, from about 10 degrees to about60 degrees. The selected angle corresponds with a radius of curvature.In some embodiments, the straight portion of the tip after the curve canhave a length less than about 1 cm, and in other embodiments from about0.1 mm to about 6 mm and in further embodiments from about 0.5 mm toabout 4 mm. In other embodiments, the curve consists of a gradual arcwith no straight section distal to it. A person of ordinary skill in theart will recognize that additional ranges of angles and lengths withinthe explicit ranges above are contemplated and are within the presentdisclosure.

The curved tip can be formed using any suitable approach, such asmolding the curved tip in the desired configuration or heating thematerial on a curved mandrel or in a curved trough to a softeningtemperature and then cooling the material on the mandrel/in the troughto fix the shape. The edge of curved tip at the opening of the cathetercan be cut straight perpendicular to the axis of the tip at the openingor at an angle relative to a straight cut. Alternatively, the edge canhave a non-planar contour. In alternative embodiments, the catheter tipis not curved. Aspiration catheter designs with improved tracking arealso discussed in published U.S. application 2007/0060944 to Boldenow etal., entitled “Tracking Aspiration Catheter,” incorporated herein byreference. A loading tool can be used to facilitate guiding a guidewireor integrated guiding structure from the distal aspiration openingthrough the guide port. A suitable loading tool can comprise a tube witha docking cavity that can accept the proximal end of the guide to feedit through the guide port.

Aspiration catheters can be formed from one or more biocompatiblematerials, including, for example, metals, such as stainless steel oralloys, e.g., Nitinol®, or polymers such as polyether-amide blockco-polymer (PEBAX®), nylon (polyamides), polyolefins,polytetrafluoroethylene, polyesters, polyurethanes, polycarbonates orother suitable biocompatible polymers. Radio-opacity can be achievedwith the addition of markers, such as platinum-iridium orplatinum-tungsten or through radio-pacifiers, such as barium sulfate,bismuth trioxide, bismuth subcarbonate, powdered tungsten, powderedtantalum or the like, added to the polymer resin. Generally, differentsections of aspiration catheter can be formed from different materialsfrom other sections, and sections of aspiration catheter can comprise aplurality of materials at different locations and/or at a particularlocation. In particular, it may be desirable to form distal compartmentor a portion thereof from an elastomeric polymer, such as suitablepolyurethanes, polydimethyl siloxane and polytetrafluoroethylene. Inaddition, selected sections of the catheter can be formed with materialsto introduce desired stiffness/flexibility for the particular section ofthe catheter. Similarly, fitting can be formed form a suitable material,such as one or more metals and/or one or more polymers.

In embodiments of particular interest, the catheter or appropriateportion thereof comprises a thermoplastic polymer with embedded metalwire, which reinforces the polymer. Suitable polymers include, forexample, polyamides, i.e., nylons. The wire can be braided, coiled orotherwise placed over a polymer tubing liner with some tension to keepthe wire in place over the tubing liner. A polymer jacket is then placedover the top. Upon heating to a temperature over the softeningtemperature of the polymer and subsequent cooling, the wire becomesembedded within the polymer. The liner and jacket can be the same ordifferent materials. Suitable wire includes, for example, flat stainlesssteel wire. The wire adds additional mechanical strength whilemaintaining appropriate amounts of flexibility. The wire can providesome radio-opacity although radiopaque bands generally would provide adarker and distinguishable image relative to the wire. However, theimage of the wire can provide further visualization of the catheterduring the procedure.

To decrease the chance of accidental removal of the radiopaque band fromthe catheter and to decrease the chance of the radiopaque band catchingonto other objects within the vessel, a metal reinforcing wire can beused to cover or enclose the radiopaque band with the metal wiresubsequently being embedded within the polymer. As described in theprevious paragraph, the metal wire can comprise interwoven wires, coil,or the like. A polymer jacket is placed over the metal wire, which iscorrespondingly covering the radiopaque band(s). Heat bonding then formsthe resulting reinforced catheter. It has been found advantageous tohave the braid-wire extend over the outer surface of the radiopaqueband. This prevents the band from being separated from the catheter inthe event that the wall is kinked or collapsed. If collapse or kinkingof the catheter wall occurs, the braid-wire over the surface of the bandcollapses down over the marker band to prevent it from separating fromthe structure.

Use of Aspiration Catheter with Filtration Device

In general, the aspiration catheters described herein can be used for avariety of procedures. For example, aspiration catheters areparticularly useful for the removal of a fiber-based device from thevessel of a patient. In particular, aspiration can be effective tocapture any emboli that may be released while the fiber cartridge isbeing converted from a deployed configuration to an appropriateconfiguration for removal. The single lumen design of the rapid exchangecatheter provides for improved loading of the fiber cartridge into thecatheter while providing improved aspiration function. The fibercartridge can be used as an embolism protection device in which thefiber cartridge is placed into a stationary position to capture emboligenerated during other treatment procedures within the vessel such as anangioplasty procedure, stent delivery or the like. In other embodiments,the fiber-based and catheter can be used in an embolectomy procedure inwhich an emboli blocking flow in the vessel are pulled with the fibercartridge to the aspiration catheter for removal of the emboli.Furthermore, the aspiration catheter can be used in a thrombectomyprocedure in which the aspiration catheter is used without a filter orthe like to aspirate thrombus deposits from within the vessel.

To stabilize the recovery process for a fiber-based device, the fibercartridge can be drawn into the distal end of the aspiration catheter.Once the fiber cartridge is comfortably within the distal compartment ofthe aspiration catheter, the risk of release of emboli is sufficientlyreduced that the suction can be stopped and the fiber-based devicesafely withdrawn with the catheter from the vessel of the patient. Thus,by drawing the fiber cartridge into a distal segment of the catheter,the disruption of natural flow in the vessel due to the suction can bekept to a level such that a shunt for the flow generally is not used.

In general, the appropriate amount of time to apply aspiration dependson the specific procedure with an increased amount of time favoringadditional collection of clots or debris while longer times foraspiration can lead to a longer period of the disruption of nature flowin the vessel. Using the improved fiber based devices described hereinand in copending applications cited herein, procedures can be safelyperformed without blocking the flow through the patient's vessel.Similarly, the use of a fiber-based device with a three dimensionalfiltration matrix provides for removal of the device into the aspirationcatheter without blocking suction into the catheter through flow throughthe matrix and/or by having a recovery configuration for the fibercartridge that does not block flow. Depending on the vessel, the amountof disruption of the flow that can be safely tolerated can be estimated,such that the process for the recovery of the embolism protection devicecan be accordingly determined. To keep disruption of the flow to lesserlevels, the suction generally is applied starting shortly before therecovery process begins. Suction generally can be maintained during theconstriction of the device configuration for fitting within the distalcompartment and while the device is drawn within the distal compartment.The suction generally is stopped once the device is within the distalcompartment and the device is not moved relative to the aspirationcatheter. Once the device is safely within the distal compartment, theaspiration catheter can be removed from the patient along with thefiber-based device.

To draw the fiber cartridge within the distal compartment of theaspiration catheter, the fiber cartridge can be converted from adeployed configuration across the vessel lumen to a recoveryconfiguration, generally with a reduced area across the cross section ofthe vessel lumen, in which the device fits within the distal compartmentof the catheter. The recovery configuration generally is similar to thedelivery configuration.

The overall timing of the recovery process involves a balance betweenseveral factors within the overall objective of keeping the period ofapplication of suction within desired ranges. To meet the objectives, itis desirable to transform the fiber cartridge to the recoveryconfiguration and load the fiber cartridge into the distal end of theaspiration catheter relatively quickly. However, sharp impacts or abruptmotions of the device raise the possibility of releasing emboli.Therefore, the loading of the device can be performed as quickly aspossible with a smooth motion. In general, it is desirable for the totaltime to transform the device to the recovery configuration and to loadthe device within the distal compartment to be no more than about fiveminutes, in other embodiments, no more than about 3 minutes, inadditional embodiments from about 2 seconds to about 2 minutes and infurther embodiments from about 5 seconds to about 1.5 minutes.

The suction is contrary to the flow within the vessel with is otherwiserelatively unrestricted. The suction rate can be greater than the flowwithin the vessel or some fraction of the flow. Specifically, thesuction rate can be no more than about 125 percent of the vessel flow,in further embodiments, no more than about 110 percent of the vesselflow, in further embodiments from about 25 percent to about 100 percentand in additional embodiments from about 50 percent to about 80 percentof the unrestricted flow through the vessel. As a particular example, ifthe unrestricted flow through the aorta is 5 liters per minute, thesuction rate can be 125 percent of the flow or 6.25 liters per minute orthe suction rate can be 25 percent of the flow or 1.25 liters perminute. A person of ordinary skill in the art will recognize thatadditional ranges of flow rates and flow percentages are contemplatedand are within the present disclosure. If the suction rate is greaterthan the natural flow rate, the suction tends to draw fluid from bothsides of the fiber cartridge into the aspiration catheter. If thesuction rate is less than the natural flow rate, the suction tends todraw fluid from the portion of the vessel adjacent the opening of theaspiration catheter. The suction rate can be selected to balance thedisruption of the flow with the collection rate for any released emboli.In some embodiments, the flow rate can change at different points in therecovery process. For variable suction rate embodiments, the suctionrate is generally greater at the start of the recovery process andreduced once the device is collapsed to a recovery configuration.

Aspiration catheters are discussed in detail in application Ser. No.10/854,920 to Galdonik et al. entitled “Emboli Filter Export System,”filed May 27, 2004 and application Ser. No. 11/207,169 to Galdonik etal. entitled “Tracking Aspiration Catheter,” filed Aug. 18, 2005.

Distribution And Packaging

The medical devices described herein are generally packaged in sterilecontainers for distribution to medical professionals for use. Thearticles can be sterilized using various approaches, such as electronbeam irradiation, gamma irradiation, ultraviolet irradiation, chemicalsterilization, and/or the use of sterile manufacturing and packagingprocedures. The articles can be labeled, for example with an appropriatedate through which the article is expected to remain in fully functionalcondition. The components can be packaged individually or together.

Various devices described herein can be packaged together in a kit forconvenience. The kit can further include, for example, labeling withinstruction for use and/or warnings, such as information specified forinclusion by the Food and Drug administration. Such labeling can be onthe outside of the package and/or on separate paper within the package.

The embodiments above are intended to be illustrative and not limiting.Additional embodiments are within the claims. In addition, although thepresent invention has been described with reference to particularembodiments, those skilled in the art will recognize that changes can bemade in form and detail without departing from the spirit and scope ofthe invention. Any incorporation by reference of documents above islimited such that no subject matter is incorporated that is contrary tothe explicit disclosure herein.

1. An actuation tool for manipulating a medical device comprising anovertube and a corewire within a lumen of the overtube, wherein aproximal end of the corewire extends from a proximal end of theovertube; the actuation tool comprising: a support structure; anovertube connection supported by the support structure, the overtubeconnection comprising a fastening element configured for gripping theovertube at or near its proximal end with the corewire extending outwardfrom the overtube; a corewire connection supported by the supportstructure the corewire connection comprising a corewire connectingelement configured to grip the corewire at or near its proximal end; anadjustable channel comprising slidably engaging elements forming a lumenbetween the engaging elements, the adjustable channel being supportedwithin the support structure, the adjustable channel extending betweenthe tube connection and the corewire connection, wherein the lumen has adiameter larger than the diameter of the corewire and wherein lateralmovement of the engaging elements changes the relative distance of theovertube connection and the corewire connection; and a control elementcomprising a rotatable element and a lateral transmission operablyconnected to the adjustable channel wherein the transmission convertsrotational motion of the rotatable element to relative translationalmotion of the engaging elements to adjust the relative distance of theovertube connection and the corewire connection to move the proximalends of the tube and the corewire toward or away from each other whenthe overtube and corewire are respectively gripped by the corewireconnection and the overtube connection.
 2. The actuation tool of claim 1wherein at least one of the tube connection and the corewire connectioncomprises a collet.
 3. The actuation tool of claim 1 wherein at leastone of the tube connection and the corewire connection comprises aclamp.
 4. The actuation tool of claim 1 further comprising a depressiblesafety button and a dial connected to the rotatable element wherein thesafety button and the dial each project outward from the supportstructure and wherein the dial comprises a notch positioned to engagethe safety button in one orientation that prevents rotation of the dialunless the safety button is depressed.
 5. The actuation tool of claim 1wherein less than about 0.050 inch of the length of the proximal end ofthe corewire that extends from the proximal end of the tube is notreceived within a channel in the control element and wherein theclearance between the channel and corewire is no more than about 0.010inch.
 6. The actuation tool of claim 1 wherein the corewire connectioncomprises a viewing area to provide for visualization of the proximalend of the corewire loaded within the actuation tool to provide forconfirmation of proper loading of the corewire in the tool.
 7. Theactuation tool of claim 1 wherein the control element comprises: a gearcomprising teeth operably connected to the rotatable element and a slidecomprising a portion of the channel operably connected with the corewireconnection, and a plurality of slide teeth engaging with the gear teethto convert the rotational movement of the rotatable element totranslation movement of the slide that moves the corewire connectionrelative to the support structure and the tube connection.
 8. Afiber-based medical device comprising: an overtube comprising a proximalend, a distal end, and a lumen extending therethrough; and a corewirecomprising a proximal end and a distal end, the corewire extendingthrough the lumen of the overtube and through the first tube; and afiber cartridge comprising: a bundle of flexible fibers; a firstradiopaque marker associated directly or indirectly with a first end ofthe bundle of flexible fibers; and a second radiopaque marker associateddirectly or indirectly with a second end of the bundle of fibers,wherein the fiber cartridge has a deployed configuration having thefirst marker and second marker projecting a single merged image.
 9. Thefiber-based medical device of claim 8 wherein the first radiopaquemarker comprises a first tube, and the second radiopaque markercomprises a second tube wherein the first tube and a second tube eachhaving a lumen through the center of the tubes, and wherein a path fromthe lumen of the first tube to the lumen of the second tube passesthrough the bundle of fibers.
 10. The fiber-based device of claim 9wherein one of the first and second tubes is insertable at leastpartially within the other tube.
 11. The fiber-based device of claim 9wherein at least one of the first end and second end of the bundle offibers is melted-bonded to the corresponding first tube and second tube.12. A medical device comprising: an overtube comprising a proximal end,a distal end, and a lumen extending there through; a corewire comprisinga proximal end and a distal end, the corewire extending through thelumen of the overtube with the proximal end of the corewire extendingfrom the proximal end of the overtube and the distal end of the corewireextending from the distal end of the overtube; a resilient segmentdirectly or indirectly attached to the distal end of the tube; and atorque coupler comprising a corewire coupling element integral with thecorewire and a resilient segment coupling element integral with theresilient segment, the corewire coupling element engaging with theresilient segment coupling element to couple the rotational motion ofthe resilient segment with the corewire.
 13. The medical device of claim12 wherein the resilient segment comprises a coil that extends from thedistal end of the tube.
 14. The medical device of claim 12 wherein thecorewire coupling element comprises a flattened key portion formed onthe outer surface of the corewire and the resilient segment lock elementcomprises a downward projecting notch formed from the resilient segment.15. The medical device of claim 12 further comprising a second torquecoupler comprising a second corewire coupling element and an overtubecoupling element, wherein the second corewire coupling element isadapted to engage with the overtube coupling element to couple therotational motion of the overtube with the corewire.
 16. A cathetercomprising: a tube comprising a polymer, the tube having a proximalportion and a distal portion; a radiopaque band in contact with thedistal portion of the tube; and metal wire, at least a portion of whichis embedded in the polymer and extending over the radiopaque band. 17.The catheter of claim 16 wherein the catheter is an aspiration catheterand further comprising a suction device connected to the proximalportion of the tube.
 18. The catheter of claim 16 wherein the metal wirecomprises a metal jacket with interwoven wires.
 19. The catheter ofclaim 16 wherein the metal wire comprises a coil.
 20. An aspirationcatheter comprising a connector, a proximal portion, a distal tip and atube connected between the distal tip and the proximal portion, whereinthe connector is attached to the proximal portion to provide apassageway to the distal tip through a continuous lumen extending fromthe proximal portion to the distal tip, wherein the distal tip has anaverage outer diameter from about 25 percent to about 90 percent of theaverage outer diameter of the tube.
 21. The aspiration catheter of claim20 wherein the outer diameter of the distal tip is tapered to graduallynarrow toward a distal aspiration opening.
 22. The aspiration catheterof claim 20 wherein the length of the distal portion is at least 1.0centimeters.
 23. The aspiration catheter of claim 20 wherein the distalportion comprises a rapid exchange segment.
 24. The aspiration catheterof claim 20 wherein the distal tip is curved.
 25. The aspirationcatheter of claim 20 wherein the distal tip has a maximum outer diameterof 0.040 inches.
 26. The aspiration catheter of claim 20 wherein thedistal tip has a maximum outer diameter of 0.025 inches and wherein theaverage outer diameter of the tube ranges from 0.05 inches to 0.10inches.
 27. A method for loading a medical device into an actuationtool, the medical device comprising an overtube and a corewire within alumen of the tube with a proximal end of the corewire extending from aproximal end of the tube and the actuation tool comprising an overtubeconnection and a corewire connection each connected to a supportstructure supporting a control element with an adjustable channel,wherein the corewire connection comprising a viewing area for observingthe corewire, the method comprising: guiding the proximal end of thecorewire into the overtube connection, the adjustable channel, and thecorewire connection until observing the corewire through the viewingarea indicating proper placement of the corewire; engaging the corewireconnection to grip the corewire extending from the proximal end of theovertube; and engaging the tube connection onto the proximal end of theovertube.